Prenatal substance exposure continues to be a major public health problem that affects millions of children and places enormous financial and social burdens on society. The Maternal Lifestyle Study (MLS) is an interagency collaboration involving the National Institute of Child Health and Human Development, the National Institute on Drug Abuse, Administration on Children, Youth and Families, and the Center for Substance Abuse Treatment. MLS is being conducted in four University sites, Miami, Tennessee at Memphis, Wayne State, and Brown and is the largest clinical prospective longitudinal study to date of prenatal drug exposure and child outcome. The follow-up cohort includes 658 exposed and 730 comparison children who have been studied through 7 years of age with 16% attrition. This proposal is to continue the follow-up through age 11. One aim is to study the effects of prenatal cocaine/opiate exposure on immediate child outcomes that start in infancy (e.g. attention, relationship to parent, neuromotor, physiologic reactivity, arousal/regulation, and medical status) as well as latent effects on domains of function that emerge later and become salient as children reach school age (e.g. cognition, antisocial behavior, substance use onset, psychopathology, neuroendocrine function and health disorders). This includes determining the effects of heavy cocaine exposure and controlling for exposure to other drugs (alcohol, marijuana, and tobacco), medical (e.g. physical growth) and environmental factors, gender, minority status and study site. The second aim is to study a broader conceptualization of the consequences of maternal drug use that includes determining how drug effects, and the effects of the postnatal environment combine to affect child outcome, including specific aspects of the environment unique to the drug culture. As a major longitudinal study MLS is important to the field of developmental science by contributing to our understanding of developmental processes in normal and at risk children. MLS will also contribute to the field by addressing health indicators related to Healthy People 2010. Understanding the consequences of prenatal cocaine exposure and risky environments is crucial for treatment and public policy.